Duty to Warn, Privilege, Third-Party Disclosures: Hardest Ethics

Clinical ethics questions feel impossible because every option sounds responsible. They are solvable: safety outranks confidentiality, law shapes what you may do, and the Code shapes what you should do. Master the three hardest clusters below with an ASWB Clinical practice test beside you.

Cluster 1: Duty to Warn vs Protect

Tarasoff duties vary by state, but the exam logic is stable. When a client threatens serious harm to an identifiable person:

1. Assess credibility: specificity, means, access, history, intoxication, psychosis.
2. If credible: protect — warn the victim, notify law enforcement, hospitalize or detain as law allows, document every step.
3. Inform the client what you must disclose and why, to the minimum necessary.

Traps: choosing rapport over protection, warning without assessing credibility, or disclosing the full record instead of the minimum. Property threats and vague venting without an identifiable target get clinical management, not warnings.

Cluster 2: Privilege vs Confidentiality

Cluster 3: Third-Party Disclosures

• Partner calls asking about the client: confirm nothing — not even enrollment — without a signed release, then redirect to the client.
• Insurance demands full notes: send the minimum necessary, inform the client, document consent or refusal.
• Group member shares outside: you cannot guarantee confidentiality in groups — state limits at intake, intervene clinically, and protect the affected member.
• Subpoena arrives: do not hand over records immediately — assert privilege, contact the client and attorney, comply only with a valid court order.

The Priority Ladder (Memorize This)

Imminent safety first. Then court order and legal mandate. Then Code duties: self-determination yields to protection from serious harm. Then agency policy. Then rapport and convenience last. When two answers both protect, choose the least restrictive, most collaborative, minimum-disclosure option — and document why in the note.